Adams ch07 lecture

PHARMACOLOGY FOR NURSESPHARMACOLOGY FOR NURSESA Pathophysiological ApproachA Pathophysiological Approach

FOURTH EDITIONFOURTH EDITION

Copyright © 2014, © 2011, © 2008 by Pearson Education, Inc.All Rights Reserved

CHAPTER

Medication Errors and Risk Reduction

7

Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban

Medication ErrorMedication Error

• Any error that occurs in medication administration process, whether or not it harms the patient. May be applied to– Misinterpretations, miscalculations– Misadministration – Handwriting misinterpretation– Misunderstanding of verbal orders


Factors That Contribute to Medication Factors That Contribute to Medication Errors by the Health Care ProviderErrors by the Health Care Provider

• Omitting one of the rights of drug administration

• Failing to perform an agency system check

• Failing to take into account for patient variables such as age, body size, and renal or hepatic function


Factors That Contribute to Medication Factors That Contribute to Medication Errors by the Health Care ProviderErrors by the Health Care Provider

• Giving medications based on verbal orders or phone orders

• Giving medication based on an incomplete order or an illegible order

• Practicing under stressful work conditions


Factors That Contribute to Factors That Contribute to Medication Errors by the PatientMedication Errors by the Patient• Taking drugs prescribed by several

practitioners • Getting prescriptions filled at more than

one pharmacy• Not filling or refilling prescriptions


Factors That Contribute to Factors That Contribute to Medication Errors by the PatientMedication Errors by the Patient• Taking medications incorrectly• Taking medications that may be left

over from a previous illness• Taking medications prescribed for

something else


Impact of Medication ErrorsImpact of Medication Errors

• Common cause of morbidity and preventable death in hospitals

• Emotionally devastating to nurse and patient

• Increased cost to patient and facility, as it may extend patient's stay


Impact of Medication ErrorsImpact of Medication Errors

• Poor reputation for unit or facility, caused by high incidence of errors

• Penalizing of administrative staff because of errors


Investigating ErrorsInvestigating Errors

• No acceptable rate of medication errors• Errors should be investigated and

subjected to analysis to determine causes.


Reporting and Documenting Reporting and Documenting Medication ErrorsMedication Errors

• Documentation should occur in a factual manner.

• Documentation in medical record must include specific nursing interventions that were implemented after the error in order to protect the patient.


Reporting and Documenting Reporting and Documenting Medication ErrorsMedication Errors

• Document all individuals who were notified of error

• Medication-administration record (MAR) is a source detailing what medication was given or omitted.


Reporting with an Incident ReportReporting with an Incident Report

• Details recorded in factual and objective manner

• Allows nurse to identify factors that contributed to the error

• Is not part of patient's hospital record• Used by agency's risk management

personnel for quality improvement


Legality and Reducing ErrorsLegality and Reducing Errors

• Accurate documentation verifies patient's safety

• Used as tool to improve drug administration processes


Legality and Reducing ErrorsLegality and Reducing Errors

• Medication errors can be reduced by using written data– Root cause analysis (RCA) seeks to

prevent another occurrence by asking what happened and why, and what can be done to prevent it


Sentinel EventsSentinel Events

• Unexpected occurrences involving death or serious physical or psychological injury, or risk thereof

• Always investigated• Interventions taken to ensure there is

no repeat


Reduction of Medication Errors and Reduction of Medication Errors and Incidents—AssessmentIncidents—Assessment

• Assess food or medication allergies• Assess current health concerns• Assess use of OTCs and herbal

supplements• Review recent laboratory tests


Reduction of Medication Errors and Reduction of Medication Errors and Incidents—AssessmentIncidents—Assessment

• Review recent physical-assessment findings

• Identify need for education of medication regimen


Reduction of Medication Errors and Reduction of Medication Errors and Incidents—PlanningIncidents—Planning

• Avoid using abbreviations that can be misunderstood

• Question unclear orders • Do not accept verbal orders


Reduction of Medication Errors and Reduction of Medication Errors and Incidents—PlanningIncidents—Planning

• Follow specific facility policies and procedures related to medication administration

• Ask the patient to participate by restating the right time and dose of medication


Reduction of Medication Errors and Reduction of Medication Errors and Incidents—ImplementationIncidents—Implementation

• Be aware of potential distractions during medication administration

• Remove distractions, if possible • Focus on the task of administering

medications • Practice the rights of medication

administration



• Keep in mind the following steps:– Positively verify patient using name and

birthdate– Use correct procedures for all routes of

administration– Calculate medication doses correctly– Open medications prior to administering– Record on MAR immediately after

administering



• Keep in mind the following steps:– Confirm patient has swallowed

medication– Be alert for long-acting oral dosage

forms with indicators such as LA, XL, and XR


Reduction of Medication Errors and Reduction of Medication Errors and Incidents—EvaluationIncidents—Evaluation

• Assess patient for expected outcomes• Determine if any adverse effects have

occurred


Nurses and ErrorsNurses and Errors

• Nurses should know most frequent types of drug errors and severities of reaction.

• Nurse should never administer a medication unless familiar with uses and side effects—PDAs now help with this.


Table 7.1 Selected Look-Alike and Sound-Alike Drug Names

continued on next slide


Table 7.1 (continued) Selected Look-Alike and Sound-Alike Drug Names

continued on next slide


Table 7.1 (continued) Selected Look-Alike and Sound-Alike Drug Names


Frequent Types of Drug Errors Frequent Types of Drug Errors

• Administering improper dose• Giving wrong drug• Using wrong route of administration


Severities Severities

• One-half of fatal medication errors occurred in patients older than 60 years of age.

• Children are another vulnerable population due to smaller dosages.


Medication ReconciliationMedication Reconciliation

• The process of “keeping track” of a patient's medications as they proceed from one health care provider to another

• Polypharmacy—patients to receive multiple prescriptions that may have conflicting pharmacologic actions


Medication ReconciliationMedication Reconciliation

• Many serious medication errors tracked to poor reconciliation

• Reconciliation lists all medications that a patient is taking to reduce errors

• Hospitals encouraged to document a complete list when patient is admitted


Educate Patient withEducate Patient with

• Written, age-appropriate handouts• Audiovisual teaching aids• Contact information


Additional Patient Education Additional Patient Education

• Know names of all medications• Know what side effects may occur• Use appropriate administration devices• Read label before each drug

administration• Carry a list of all medications, including

OTC and herbals• Ask questions


Methods to Reduce Number of Methods to Reduce Number of Medication ErrorsMedication Errors

• Automated, computerized, locked cabinets for medication storage on patient-care units

• Risk-management departments to examine risks and minimize the number of medication errors


Methods to Reduce Number of Methods to Reduce Number of Medication ErrorsMedication Errors

• Electronic health records and e-prescriptions

• Barcode-assisted medication administration


Examples of Beneficial Policies and Examples of Beneficial Policies and ProceduresProcedures

• Correctly storing medication• Reading drug label• Avoid drug transfer between containers• Avoid overstocking to prevent

expiration• Monitor compliance with current

medication abbreviations• Removing outdated reference books


Governmental and Other Agencies Governmental and Other Agencies that Track Medication Errorsthat Track Medication Errors

• FDA's MedWatch– Health care providers are encouraged to

report errors.– Errors may be reported anonymously.

• Institute for Safe Medication Practices (ISMP)

• MEDMARX - U.S. Pharmacopeia's anonymous medication error reporting program

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